A patient is brought to the Emergency Department with a gunshot wound to the chest. The healthcare professional assesses an abnormality involving a pleural rupture that acts as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing during expiraton. What action by the healthcare professional is the priority?

A. Pneumonia: Pneumonia is a common cause of acute respiratory distress syndrome (ARDS) and is associated with significant inflammation and alveolar damage. Assessing for pneumonia is a priority as it can exacerbate ARDS and lead to further respiratory compromise. Early identification and treatment of pneumonia can significantly improve the patient's outcome.

B. Heart failure: While heart failure can contribute to respiratory distress, ARDS is primarily a non-cardiogenic condition. Assessing for heart failure is important, but pneumonia is more directly linked to the development of ARDS and should be prioritized.

C. Pulmonary emboli: Although pulmonary embolism can cause acute respiratory distress, it is not the primary concern when dealing with ARDS. Assessing for embolism is important, but pneumonia is a more common and immediate concern in the context of ARDS.

D. Acute pulmonary edema: Acute pulmonary edema is usually associated with cardiac issues and is not the underlying cause of ARDS. While monitoring for pulmonary edema is necessary, pneumonia is the more relevant condition to assess in a patient diagnosed with ARDS.

A. Assist with a chest tube insertion: A gunshot wound to the chest with a one-way valve pleural rupture indicates a tension pneumothorax, a life-threatening condition. Air enters the pleural space with each breath but cannot escape, leading to increased intrathoracic pressure, lung collapse, and mediastinal shift, which can compromise venous return and cardiac output. Immediate chest tube insertion or needle decompression is necessary to relieve pressure and restore normal lung function.

B. Give the patient low-flow oxygen: Oxygen therapy may help improve oxygenation, but it does not address the underlying issue of trapped air causing intrathoracic pressure buildup. Without intervention to release the trapped air, respiratory distress and cardiovascular collapse can occur.

C. Assess for clubbing of fingernails: Clubbing is a sign of chronic hypoxia seen in long-term respiratory diseases but is not relevant in the acute management of a tension pneumothorax. The priority is to relieve the trapped air and restore normal lung expansion.

D. Draw arterial gases: While arterial blood gases can help assess oxygenation and ventilation status, they do not treat the underlying tension pneumothorax. Immediate decompression is required before diagnostic tests to prevent rapid deterioration and potential cardiac arrest.